The deaths of two young children found in their Wellesley home in April were caused by mechanical asphyxia and acute intoxication from multiple substances, according to the Massachusetts state medical examiner’s office. Six-year-old Ella MacAusland and seven-year-old Kai MacAusland died from asphyxiation due to external pressure restricting their breathing, combined with the effects of several drugs including zolpidem, acetaminophen, ibuprofen, and lorazepam.

Zolpidem, sold under the brand name Ambien, is prescribed to aid sleep, while lorazepam, commonly known as Ativan, is used to treat anxiety. Acetaminophen and ibuprofen are non-prescription pain relievers. The medical examiner’s report was released on Wednesday.

The medical findings were disclosed just days after Janette MacAusland, the children’s mother and a 49-year-old resident of Wellesley, was indicted by a Norfolk County grand jury on two counts of first-degree murder. Authorities allege that MacAusland caused the deaths “on or about” April 22.

Following the incident, MacAusland fled to Vermont, where she arrived at her aunt’s home visibly distraught and reportedly admitted to killing her children. Vermont authorities conducted a welfare check that led to the discovery of the two children’s bodies in their family home on April 24.

During her initial statements to investigators, MacAusland allegedly confessed to strangling her children and expressing intentions of attempting suicide, hoping they could all “go to God together but it didn’t work.”

After her arrest in Vermont, MacAusland was extradited back to Massachusetts and has pleaded not guilty to the charges in Dedham District Court. She remains held without bail. Her arraignment in Norfolk Superior Court is scheduled for November 3. The Norfolk District Attorney’s office declined to comment on the medical examiner’s findings.